Cypress pollen: an unexpected major sensitizing agent in different regions of Italy

OBJECTIVES

In this multicenter survey, we assessed the impact of sensitization to cypress in atopic patients in Italy and determined whether cypress pollen concentration changed over time.

METHODS

Allergists were required to collect the results of 100-200 consecutive skin prick tests (SPTs) performed during 2012. Seasonal symptoms were also recorded, as were airborne cypress pollen concentrations (data from the Italian Aerobiology Association) in 1998-2000 and 2010-2012.

RESULTS

We examined 2258 atopic outpatients (56% females; age, 2-84 years) sensitized to at least 1 of the aeroallergens tested (Dermatophagoides species, grass, pellitory, olive, cypress, birch, Alternaria tenuis, and dog and cat dander). We found that 62.9%, 16.1%, and 32.7% of patients living in central, northern, and southern Italy, respectively, were sensitized to cypress (P < .0001). The cypress pollen concentration peak was delayed from February to March in 1998-2000 and 2010-2012 in all 3 regions, with a shift in pollination towards spring. Patients who were monosensitized to cypress reported mainly rhinitis (90.7%-97.6%) and conjunctivitis (38.1%-100%). In polysensitized patients, the prevalence of rhinitis, conjunctivitis, and asthma increased progressively (P < .0001) from southern to northern Italy. The same trend was observed for the prevalence of reported winter symptoms typical of cypress allergy (28%-65%).

CONCLUSIONS

Today, cypress pollen is the most frequent sensitizing aeroallergen (assessed by SPT) in several areas of central Italy. Variations in the timing of the cypress pollination period may have favored this increased sensitization. Rhinitis and conjunctivitis are the predominant symptoms. The clinical impact of this allergy was poor in southern Italy and increased in central areas before reaching its peak in northern regions.

Small plasma focus as neutron pulsed source for nuclides identification

In this paper, we present preliminary results on the feasibility of employing a low energy (2 kJ, 31 kV) plasma focus device as a portable source of pulsed neutron beams (2.45 MeV) generated by nuclear fusion reactions D-D, for the "in situ" analysis of substances by nuclear activation. This source has the relevant advantage of being pulsed at requirement, transportable, not permanently radioactive, without radioactive waste, cheap, among others. We prove the feasibility of using this source showing several spectra of the characteristic emission line for manganese, gold, lead, and silver.

Sensitization to horse allergens in Italy: a multicentre study in urban atopic subjects without occupational exposure

BACKGROUND

Horses play a significant role in people's leisure time in Italy and other countries, but few data are available on IgE-mediated sensitization to horse allergens in patients without occupational exposure. We assessed, in a multicentric survey, the prevalence of horse sensitization in atopic subjects and its clinical characteristics.

METHODS

Allergists from the whole Italian territory were required to collect the results of skin prick tests from at least 100 consecutive subjects. Those patients with a positive skin test to horse dander underwent a detailed interview concerning clinical history, pet ownership and possible exposure.

RESULTS

Data from 3,235 outpatients were collected and 2,097 had at least 1 skin positivity. Among them, 113 (5.38%) were sensitized to horse dander (9 monosensitized). Thirty patients reported direct horse contact (4 owners and 26 for riding or occasional contact), 23 patients were sometimes in contact with horse owners and 60 subjects denied any direct or indirect exposure. Among 9 horse monosensitized patients, 6 had intermittent and mild rhinitis and 3 persistent moderate/severe rhinitis plus asthma. Three of them were horse owners or riders and the remaining had no contact with the animal.

CONCLUSIONS

Our data evidence that the rate of sensitization to horse dander is not negligible and probably underestimated. In susceptible, not occupationally exposed individuals, horse contact, but also indirect or no apparent exposure, may induce sensitization. We recommend inclusion of horse allergen in the routine panel for the diagnosis of respiratory allergy.

γ-Amino butyric acid (GABA) release in the ciliated protozoon Paramecium occurs by neuronal-like exocytosis

Paramecium primaurelia expresses a significant amount of γ-amino butyric acid (GABA). Paramecia possess both glutamate decarboxylase (GAD)-like and vesicular GABA transporter (vGAT)-like proteins, indicating the ability to synthesize GABA from glutamate and to transport GABA into vesicles. Using antibodies raised against mammalian GAD and vGAT, bands with an apparent molecular weight of about 67 kDa and 57 kDa were detected. The presence of these bands indicated a similarity between the proteins in Paramecium and in mammals. VAMP, syntaxin and SNAP, putative proteins of the release machinery that form the so-called SNARE complex, are present in Paramecium. Most VAMP, syntaxin and SNAP fluorescence is localized in spots that vary in size and density and are primarily distributed near the plasma membrane. Antibodies raised against mammal VAMP-3, sintaxin-1 or SNAP-25 revealed protein immunoblot bands having molecular weights consistent with those observed in mammals. Moreover, P. primaurelia spontaneously releases GABA into the environment, and this neurotransmitter release significantly increases after membrane depolarization. The depolarization-induced GABA release was strongly reduced not only in the absence of extracellular Ca2+ but also by pre-incubation with bafilomycin A1 or with botulinum toxin C1 serotype. It can be concluded that GABA occurs in Paramecium, where it is probably stored in vesicles capable of fusion with the cell membrane; accordingly, GABA can be released from Paramecium by stimulus-induced, neuronal-like exocytotic mechanisms.

Topical oropharyngeal vancomycin to control methicillin-resistant Staphylococcus aureus lower airway infection in ventilated patients

AIM

Topical vancomycin applied to the oropharynx has been shown to control carriage and lower airway infection due to methicillin-resistant Staphylococcus aureus (MRSA). We undertook a three-year prospective observational study to evaluate the effectiveness of two policies for topical vancomycin administration on oropharyngeal carriage and lower airway infection due to MRSA in patients requiring mechanical ventilation.

METHODS

All consecutive patients aged over 18 years and expected to require mechanical ventilation for more than 72 hours were enrolled. During period one, patients who were established MRSA carriers received 1 g of 4% vancomycin gel into the oropharynx four times a day until carriage was abolished. During period two, all enrolled patients received the same protocol immediately on admission, irrespective of their MRSA carrier state.

RESULTS

One hundred ninety-one patients met the entry criteria (98 in period one and 93 in period two). During period one, 40 patients developed oropharyngeal MRSA carriage; of these, 29 acquired MRSA in the unit. In contrast, MRSA carriage was not demonstrated during period two (relative risk [RR] 0.018, 95% confidence interval [CI] 0-0.29; P=0.004). Twenty-one patients from period one suffered from an Intensive Care Unit-acquired lower airway infection due to MRSA, compared with five patients from period two (RR 0.25, 95% CI 0.10-0.64, P=0.004). Vancomycin-intermediate Staphylococcus aureus and vancomycin-resistant enterococci were not isolated.

CONCLUSION

In the setting of MRSA endemicity, the prevention of MRSA carriage by topical oropharyngeal vancomycin was more effective in reducing carriage and infection of the lower airways than treatment of established carriers.

MBL2 and MASP2 gene polymorphisms in patients with hepatocellular carcinoma

The pathogenesis of hepatocellular carcinoma (HCC) is not fully understood, but the majority of patients with HCC are associated with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. Mannan-binding lectin (MBL) is a collectin that can act directly as opsonine or activate MBL-associated serine proteases (MASPs) thus initiating the antibody-independent pathway of the complement system. In our study, we analysed two MBL2 and MASP2 functional polymorphisms (MBL2 allele A/0 and MASP2 D120G) as well as MASP2 polymorphism (Y371D) responsible for an amino acidic change in the protein in 215 HCC patients (HBV-infected, HCV-infected, HBV/HCV co-infected and patients with HCC with no viral infection) and 164 healthy controls to give new insights regarding the role of these two molecules in HCC and viral infection pathogenesis. No significant association was found between MBL2 or MASP2 alleles or genotypes, neither comparing the total patients with HCC and healthy controls nor between the different groups of HCC subjects divided for type of viral infection. Also, dividing the total HCC patients group into low MBL producer (A0 and 00 genotypes) and normal producer (AA genotype) and comparing MASP2 polymorphisms in these two groups, no significant differences were found. Our data do not seem to suggest a role for MBL2 and MASP2 polymorphisms in HCC susceptibility either for HBV-HCV infection-dependent HCC or for HCC raised as a consequence of exposure to different risk factors.

The expression of innate immunity genes in Italian Crohn disease patients

Crohn' disease (CD) is a chronic idiopathic inflammatory bowel disease characterized by the interaction of both hereditary and environmental factors. Intestinal flora and pathogens such as bacteria, viruses and fungi, are thought to be the first step leading to an inflammatory status, which is subsequently amplified in genetically susceptible patients thus triggering the disease. Since the innate immune system is believed to be very important in regulating the flora of the gastrointestinal tract, we decided to study the influence of two important molecules of the innate immune system in CD. Frozen intestinal biopsies from 49 Crohn patients and 10 healthy individuals were collected at the gastroenterology unit of Children's Hospital Burlo Garofolo in Trieste and innate immunity gene expression was evaluated by using both in situ RT-PCR and quantitative PCR. We have analyzed the expression and localization of both MBL2 and DEFB1 genes in intestinal biopsies of Italian Crohn patients by in situ RT-PCR and quantitative PCR. DEFB1 is expressed equally in all subjects. Importantly, MBL2 transcripts were upregulated in CD patients compared to healthy controls. MBL2 expression in controls is normally extremely low, detectable only by quantitative PCR with a Taqman probe. We demonstrated the MBL2 and DEFB1 expression in intestinal biopsies of patients suffering from CD. Our results showed that the MBL2 gene is expressed by cells in the basal lamina, whilst DEFB1 is expressed by epithelial cells.

Selective decontamination of the digestive tract reduces bacterial bloodstream infection and mortality in critically ill patients. Systematic review of randomized, controlled trials

A systematic review and meta-analysis of randomized controlled trials (RCTs) of selective decontamination of the digestive tract (SDD) was undertaken to evaluate the impact of this procedure on bacterial bloodstream infection and mortality. Data sources were Medline, Embase, Cochrane Register of Controlled Trials, previous meta-analyses, and conference proceedings, without restriction of language or publication status. RCTs were retrieved that compared oropharyngeal and/or intestinal administration of antibiotics as part of the SDD protocol, with or without a parenteral component, with no treatment or placebo in the controls. The three outcome measures were patients with bloodstream infection, causative micro-organisms, and total mortality. Fifty-one RCTs conducted between 1987 and 2005, comprising 8065 critically ill patients were included in the review; 4079 patients received SDD and 3986 were controls. SDD significantly reduced overall bloodstream infections [odds ratio (OR), 0.73; 95% confidence interval (CI), 0.59-0.90; P=0.0036], gram-negative bloodstream infections (OR, 0.39; 95% CI, 0.24-0.63; P<0.001) and overall mortality (OR, 0.80; 95% CI, 0.69-0.94; P=0.0064), without affecting gram-positive bloodstream infections (OR, 1.06; 95% CI, 0.77-1.47). The subgroup analysis showed an even larger impact of SDD using parenteral and enteral antimicrobials on overall bloodstream infections, bloodstream infections due to gram-negative bacteria and overall mortality with ORs of 0.63 (95% CI, 0.46-0.87; P=0.005), 0.30 (95% CI, 0.16-0.56; P<0.001), and 0.74 (95% CI, 0.61-0.91; P=0.0034), respectively. Twenty patients need to be treated with SDD to prevent one gram-negative bloodstream infection and 22 patients to prevent one death.

CCR5 promoter polymorphisms and HIV-1 perinatal transmission in Brazilian children

The frequencies of four CCR5 promoter polymorphisms, and of the Delta32 deletion, have been evaluated in Brazilian HIV-1 positive (HIV+) and HIV-1 negative (HIV-) children, both born from HIV-1 positive mothers and healthy controls (HC), with the aim of investigating whether CCR5 polymorphisms could be associated to vertical transmission of HIV-1. One hundred and six HIV-1 positive children and 70 HIV-1 negative children were enrolled from impoverished areas of Recife (Brazil). We recruited also as healthy controls 104 uninfected children from the same ethnic background, matched for age and known to be not at risk for HIV-1 infection. CCR5 polymorphisms were detected by PCR amplification and direct sequencing. Although no significative divergence was found for CCR5 Delta32, CCR5-59356-C/T and CCR5-59653 C/T polymorphisms, the frequency of CCR5-59353-T/C and CCR5-59402-A/G genotypes differed among HIV+, HIV- and HC children. The presence of the CCR5-59353-TT genotype indicated a trend for increased risk of vertical transmission of HIV-1 infection in Brazilian children, while the presence of the CCR5-59402-AA genotype is suggestive for a protective effect against HIV-1 vertical transmission.

Time-course of diastolic dysfunction in different stages of chronic HCV related liver diseases

AIM

A hyperdynamic circulatory pattern in advanced liver disease is known since a long time. The first studies evaluating cardiac function in cirrhosis were performed in patients with alcoholic liver disease and thus this condition was attributed to the toxic effects of ethanol. A reduced performance of the left ventricle after physical and pharmacological strains along with an altered diastolic function has been demonstrated also in postviral cirrhosis. Many factors are involved in advanced cirrhosis whereas little is known in the earlier stages of disease.

METHODS

To this aim we have investigated patients with different stages of hepatitis C virus (HCV)-related liver disease to detect the time-course of diastolic dysfunction. An impaired relaxation and increased thickness of left ventricular walls along with an altered pattern of transmitral flow can be easily detected by means of echocardiography.

RESULTS

In chronic hepatitis diastolic function is preserved but increased thickness of left ventricle parietal walls can be detected in patients with fibrosis on liver biopsy. The typical pattern of diastolic dysfunction is observed in Child A cirrhotic patients and in Child C ascitic patients but thickness of parietal walls is more relevant in the former group. Chronic aldosterone blockade could exert favourable effects in heart remodeling suggesting a potential role of these drugs in cirrhotic cardiomyopathy.

CONCLUSIONS

The presence of increased thickness of left ventricle parietal walls in chronic hepatitis C in the precirrhotic stage point to a putative role of HCV in this heart structural abnormality that can become a co-factor in the more advanced stages of cirrhosis when portal hypertension and its deleterious effects on systemic hemodynamics, cardiac function and structure become manifest.

Eosinophils, specific hyperreactivity and occurrence of late phase reaction in allergic rhinitis

BACKGROUND

Eosinophil infiltration may be considered characteristic of nasal allergic inflammation. However, a mild inflammatory infiltrate may be present in asymptomatic subjects exposed to specific allergen.

OBJECTIVE

We investigated the relationship between inflammation, specific hyperreactivity and clinical late phase reactions in allergic subjects using the ASNC model.

METHODS

Sixty allergic subjects (aged from 18 to 47 years) were enrolled among those sensitized to pollens (n=20) and those to house dust mite with (n=20) or without (n=20) known clinical nasal LPR. All subjects were asymptomatic. TNSS and eosinophil number were assessed at baseline, 30 min (early phase) and 6 hours (late phase) after ASNC.

RESULTS

Eosinophil number was higher in LPR+ rhinitics than in other groups, at baseline and during the early and late phase (p<0.001). ATD was lower in LPR+ rhinitics than in other groups (p<0.001). In LPR+ rhinitics, at baseline there was a significant correlation between eosinophils and ATD (r=0.56, p=0.009). After allergen challenge, TNSS was significantly higher in LPR+ rhinitics than in other groups, both during early and late phase (p<0.001 for all comparisons).

CONCLUSIONS

In house dust mite sensitised subjects, LPR occurrence after allergen challenge is associated with higher inflammation and lower ATD at baseline. Therefore, in house dust mite allergy minimal persistent inflammation without symptoms can drive different clinical responses to allergen challenge.

Nasal eosinophils correlate with FEV1 in patients with perennial allergic rhinitis associated to asthma

BACKGROUND

Eosinophil inflammation is present in nasal and bronchial mucosa and a clear link between upper and lower airways exists. Our aim was to evaluate whether nasal inflammation correlates with lung function in patients with perennial allergic rhinitis associated with asthma.

METHODS

Eighty perennial allergic rhinitics with mild asthma, aged from 18 to 46 years, were enrolled. Nasal scraping and spirometry were performed in all subjects.

RESULTS

A close relationship between the nasal eosinophil number and the percentage of predicted FEV1 was demonstrated (r = -0.76; p<0.0001). CONCLUSIONS Nasal cytology may be considered a non-invasive tool to assess airway inflammation in mild asthmatics with associated allergic rhinitis.

Airway function and nasal inflammation in seasonal allergic rhinitis and asthma

BACKGROUND

Allergic rhinitis (AR) and asthma are frequently associated and characterized by a Th2-dependent inflammation. Nasal and bronchial obstruction may be objectively measured.

OBJECTIVE

The aim of this study was to evaluate the relationships among upper and lower airway function and nasal inflammation in subjects with seasonal allergic rhinitis (SAR) and asthma.

METHODS

Twenty out-patients (12 males and eight females, mean age: 23.4+3.6 years) with SAR and asthma were evaluated during the pollen season. All of them showed a moderate-severe grade of nasal obstruction. Total symptom score, rhinomanometry, spirometry, nasal lavage, and nasal scraping were obtained in all subjects. Eosinophils were counted by conventional staining; IL-4 and IFN-gamma were measured by immunoassay on fluids recovered from nasal lavage.

RESULTS

Functional parameters, i.e. nasal airflow and forced expiratory volume in 1 s (FEV(1)), were correlated with nasal eosinophils (R(2)>0.83, P<0.001). Inflammatory parameters, i.e. eosinophils were correlated with immunological parameters, i.e. IL-4 and IFN-gamma levels (R(2)=0.93, P<0.001). Nasal symptoms were correlated with nasal airflow (rho=-0.71, P< or =0.01) and eosinophils (rho=0.72, P<0.01). Nasal airflow was correlated with FEV(1) (r=0.89, P<0.0001).

CONCLUSIONS

This study demonstrates the close connection between Th2 cytokines and eosinophil infiltration in the nose. There is also clear evidence concerning the relationships between eosinophils infiltration and cytokines levels. Nasal eosinophils can be regarded as the most important predictors of upper and lower airway functions. These findings constitute first evidence of a relationship among nasal Th2-related inflammation and nasal and bronchial airflow in patients with SAR and asthma.

Cetirizine reduces cytokines and inflammatory cells in children with perennial allergic rhinitis

Cetirizine has been demonstrated able of reducing nasal inflammatory infiltration in children with allergic rhinitis and cytokine production in in vitro studies. The aim of this double-blind, placebo-controlled, and randomized study was to evaluate cytokine pattern and inflammatory cells in children with perennial allergic rhinitis, before and after treatment with cetirizine or placebo. Twenty children with perennial allergic rhinitis were evaluated, 13 males and 7 females (mean age 13.4 years). Inflammatory cells and cytokines were evaluated by scraping and nasal lavage, before and after 2-weeks administration of cetirizine or placebo. IL4 and IL8 were measured by immunoassay and inflammatory cells were counted by conventional staining. Cetirizine treatment induced a significant decrease of IL4 (p<0.01) and IL8 levels (p=0.01). A significant reduction of the inflammatory cells was detected in actively-treated children, both concerning neutrophils and eosinophils (p<0.01). Moreover, cetirizine significantly reduced nasal obstruction score (p=0.007). This study shows the cetirizine effectiveness in exerting anti-inflammatory activity by modulating cytokine pattern and by reducing inflammatory infiltration in children with perennial allergic rhinitis.

Prevention of MRSA pneumonia by oral vancomycin decontamination: a randomised trial

This study was undertaken to assess whether oropharyngeal vancomycin may control oropharyngeal carriage and lower airway infection due to methicillin-resistant Staphylococcus aureus (MRSA) acquired in the intensive care unit (ICU). Secondary endpoints were the emergence of vancomycin-resistant enterococci, vancomycin-intermediate S. aureus and vancomycin consumption. A total of 84 patients, admitted to a medical/surgical ICU and mechanically ventilated for >72 h, were randomly assigned to control (n=42) or test (n=42) group. Both groups received the protocol of selective decontamination of the digestive tract, including polymyxin E, tobramycin and amphotericin B. Patients in the test group received 0.5 g of a 4% vancomycin gel at 6-h intervals in the oropharynx. Lower airway infections due to MRSA acquired on the ICU were reduced in the test group, as was oropharyngeal carriage. Neither vancomycin-resistant enterococci nor vancomycin-intermediate S. aureus were isolated from either surveillance or diagnostic samples during the study period. The vancomycin costs were lower in the test group. This study demonstrates that oropharyngeal vancomycin, which controls intensive care unit-acquired lower airway infections and secondary carriage due to methicillin-resistant Staphylococcus aureus, is cost-effective and safe in terms of vancomycin-resistant enterococci and vancomycin-intermediate Staphylococcus aureus.

Nasal cytokine modulation by montelukast in allergic children: a pilot study

BACKGROUND

Allergic rhinitis and asthma are characterized by chronic inflammation due to a Th2 cytokine polarization. Leukotrienes receptor antagonists have been shown to be effective in both diseases.

OBJECTIVE

Aim of the study was to evaluate the modulation by the antileukotriene montelukast on Th2 and Th1 cytokines in allergic rhinitis.

METHODS

Fourteen school children affected by persistent allergic rhinitis (PAR) and exercise-induced asthma (EIA) underwent a nasal lavage before and after a two-week treatment with montelukast. A panel of cytokines, including IL4, IL13, and IFN gamma, was measured by immunoassay on nasal lavage samples.

RESULTS

Montelukast treatment induced a significant decrease of IL4 and IL13 levels (p < 0.001, for both comparisons), and a significant increase of IFN gamma (p < 0.001).

CONCLUSIONS

Montelukast treatment reversed a typical Th2 cytokine pattern (IL4 and IL13) toward a Th1 (IFN gamma) predominance in children with PAR and EIA. This effect could be considered relevant for long term allergic inflammation control and of interest when treating EIA with concomitant PAR.

Long-term cetirizine treatment may reduce new sensitisations in allergic children: a pilot study

Experimental data demonstrate that mite allergy is characterized by persistent chronic inflammation. This suggests that long-term continuous treatment may be included in the global strategy of allergy management as recently reported. Moreover, most of allergic subjects show polysensitisation. We conducted a study to investigate whether a long-term cetirizine treatment may reduce the occurence of new sensitisations in children with mite allergy. This study was initially double-blind, randomized, and placebo-controlled, with two parallel groups of 10 children with mite allergy receiving either cetirizine or placebo daily. All children could assume cetirizine as rescue medication (i.e. symptomatic treatment). After six months, parents of continuously-treated children decided to continue the treatment for 3 years. Other subjects continued to assume cetirizine on symptomatic basis. All children were prospectively followed for other 3 years. Outcome measure was skin prick test, yearly performed. Cetirizine-continuously-treated group showed a significant lower incidence of new sensitisations (p = 0.002). In conclusion, cetirizine administered daily for prolonged periods (i.e. 3 years) may decrease the development of new sensitisations in monosensitised children, showing a potential effect of tertiary prevention of allergy.

Most nosocomial pneumonias are not due to nosocomial bacteria in ventilated patients. Evaluation of the accuracy of the 48 h time cut-off using carriage as the gold standard

A prospective observational cohort study was undertaken with two endpoints: (1) to compare the time cut-off of 48h and the carrier state criterion for classifying lower airway infections in adult and paediatric long-term ventilated patients, and (2) to evaluate the potential of optimized time cut-offs for characterizing imported and ICU-acquired lower airway infections. All patients admitted to the general and paediatric intensive care units and expected to require mechanical ventilation for a period > or = 3 days were enrolled. Surveillance cultures of throat and rectum were obtained on admission and thereafter twice weekly to distinguish micro-organisms that were imported into the unit from those acquired during the stay on the unit. A total of 130 adults and 400 children were studied. In the adult population, 70% of lower airway infections were classified as ICU-acquired by the 48 h cut-off and 48% by the criterion of carriage; on the paediatric ICU the percentages were 65% and 20%, respectively. To separate imported from ICU-acquired infections, eight days was optimal in the adult population and 10 days in the paediatric population. Sensitivity, specificity, positive predictive value and negative predictive value for a time cut-off of eight days for adults were 86, 77, 80, 83%, respectively, and using 10 days for children were 87, 62, 90, 56%, respectively. The use of the 48 h cut-off rule classifies patients as having nosocomial pneumonia, when in fact the infections are commonly caused by microorganisms carried in by the patients. In contrast, using the carriage method, the proportion of lung infections due to nosocomial bacteria was relatively small and was a late phenomenon. Although in prolonging the time cut-off the difference between the two types of classification was shorter, time cut-offs were still found to be unreliable for distinguishing imported from unit-acquired lower airway infections.

Role of leukotriene receptor antagonists in the management of mild-to-moderate asthma

To date the position of Leukotriene Receptor Antagonists (LTRAs) in asthma is not yet fully established. Recent asthma guidelines consider LTRAs as 'alternative' to low doses of inhaled corticosteroids (ICS) for treatment of patients with mild persistent asthma, while in Europe LTRAs are licensed as additional therapy to ICS. Our aim in this paper is to review comparative studies between ICS and antileukotrienes in mild to moderate asthma, looking at their efficacy on asthma outcomes and on patient expectations (compliance, quality of life, and safety). Some studies report a superior efficacy of ICS, while others, in particular in patients aged < 12 years, found no differences. When considering patients' expectations LTRAs seem to be superior, with higher compliance and quality of life. Even if no differences in adverse effects have been found between ICS and LTRAs, whose safety profiles are not different from placebo, some concerns exist on long term treatment with ICS, even at low doses, in children and postmenopausal women. For this reason, even if ICS are superior to LTRAs in controlling asthma outcomes and in improving pulmonary function, in children and elderly patients LTRAs can be considered an alternative to low-dose ICS.

Fexofenadine reduces nasal congestion in perennial allergic rhinitis

BACKGROUND

Nasal congestion is the predominant symptom in perennial allergic rhinitis (PAR), and it seems to be mainly related to the late-phase inflammatory events. The present pilot study aimed to evaluate the therapeutic effect exerted by fexofenadine in patients with PAR due to mite allergy.

METHODS

This study was a parallel, double-blind, randomized, three-arm (1:1:1), placebo-controlled study. Thirty-one subjects with PAR were enrolled and received double-blind medication: fexofenadine 120 or 180 mg, or placebo, once a day for 28 days.

RESULTS

The total symptom score was reduced by fexofenadine (both dosages) at V2 (P=0.007), whereas placebo did not modify it. Nasal congestion decreased after 1 week of treatment with fexofenadine 120 (P=0.027) and 180 (P=0.01), but not with placebo (P=NS). At V3, fexofenadine (both dosages) significantly reduced nasal congestion (P=0.011 and P=0.007, respectively), by placebo did not show any significant effect.

CONCLUSIONS

This pilot study represents the first evidence of the efficacy of fexofenadine in PAR, and also the control of the nasal congestion. We suggest performing larger trials to confirm these preliminary findings.

On the functional consequences of bronchial basement membrane thickening

Reticular basement membrane (RBM) thickness and airway responses to inhaled methacholine (MCh) were studied in perennial allergic asthma (n = 11), perennial allergic rhinitis (n = 8), seasonal allergic rhinitis (n = 5), and chronic obstructive pulmonary disease (COPD, n = 9). RBM was significantly thicker in asthma (10.1 +/- 3.7 microm) and perennial rhinitis (11.2 +/- 4.2 microm) than in seasonal rhinitis (4.7 +/- 0.7 microm) and COPD (5.2 +/- 0.7 microm). The dose (geometric mean) of MCh causing a 20% decrease of 1-s forced expiratory volume (FEV(1)) was significantly higher in perennial rhinitis (1,073 microg) than in asthma (106 microg). In COPD, the slope of the linear regression of all values of forced vital capacity plotted against FEV(1) during the challenge was higher, and the intercept less, than in other groups, suggesting enhanced airway closure. In asthma, RBM thickness was positively correlated (r = 0.77) with the dose (geometric mean) of MCh causing a 20% decrease of FEV(1) and negatively correlated (r = -0.73) with the forced vital capacity vs. FEV(1) slope. We conclude that 1) RBM thickening is not unique to bronchial asthma, and 2) when present, it may protect against airway narrowing and air trapping. These findings support the opinion that RBM thickening represents an additional load on airway smooth muscle.